Summary / Abstract

Title: Adolescent homicide: towards assessment of risk

Synopsis: Recent murders committed by children and adolescents have raised concern over the detection andmanagement of dangerous youngsters in our society. Yet in the training of child and adolescent mental health professionals theassessment and management of dangerousness to others is frequently given little attention. This paper attempts to begin to redressthe balance by reviewing the mental health literature relevant to homicidal children and adolescents. Background and situationalfactors relevant to risk are described. Background factors include the witnessing of serious violence, both live and on the screen,as well as abuse through neglect and deprivation. Such trauma can assist in the creation of a morbid identity and a cognitive setthat make murder possible in certain situations. Other background factors include learning difficulties and problems with impulsecontrol. However even if a youngster is assessed as highly dangerous it is frequently difficult in the current climate to offeradequate intervention. Issues in the prevention of violence are considered. Through abuse my emotions and self-respect weremurdered and so I no longer cared. Do people stand trial for killing someone's insides? No, because you can't produce acorpse... (a teenage killer). adolescents, violence, homicide, youngsters, risk, abuse, murder, assessment, mental health, child, violent, literature, attention, professionals, morbid identity, situations, learning difficulties, violent behaviour, deprivation, dangerousness, dangerous youngsters, adolescent murderers, developmental pathways, non violent, health literature relevant, self esteem, United States, mental health services, intervention, commits murder,

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journal adolescence 1996 19 263 276 adolescent homicide assessment risk peter j hardwick martyn rowton lee recent murders committed children adolescents raised concern detection management dangerous youngsters society training child adolescent mental health professionals assessment management dangerousness frequently little attention paper attempts begin redress balance reviewing mental health literature relevant homicidal children adolescents background situational factors relevant risk described background factors witnessing serious violence live screen abuse neglect deprivation trauma assist creation morbid identity cognitive make murder possible situations background factors learning difficulties problems impulse control youngster assessed highly dangerous frequently difficult current climate offer adequate intervention issues prevention violence considered abuse emotions self respect murdered i longer cared people stand trial killing insides t produce corpse teenage killer 1996 association professionals services adolescents introduction light recent concerns homicides committed children adolescents likely increased expectations child adolescent mental health services assessment management highly dangerous youngsters mental health workers suffer times nightmare adolescent seen clinic goes commits murder able predict behaviour issue assessment homicide risk management appear figure highly training specifically predictive factors differentiate murder opposed non homicidal aggression homicidal behaviour suspected helping agencies best intervene bearing mind antisocial youngsters prefer avoid attempting address questions authors studied area adolescent homicide mental health literature notable exceptions validity studies field juvenile homicide restricted small numbers cases research literature frequently comprises individual case studies small collections cases comparison control groups themes issues ideas extracted presented chance plays large reprint requests correspondence addressed dr p j hardwick b sc m b ch b f r c psych consultant child adolescent psychiatrist east dorset department child family mental health boscombe community hospital 11 shelley road boscombe bournemouth dorset bh1 4jq u k 0140 1971 96 03026314 18 00 0 1996 association professionals services adolescents 264 p j hardwick m rowton lee determining youngster violent act homicide considered key areas general literature adolescent violence incidence united states number juveniles 18 arrested murder manslaughter rose 60 1981 1990 rise arrests 18 modest shepherd farrington 1995 alarming figures back drop general increase non lethal violent crimes committed young violent offending major public health issue north america u k juvenile violent crime general steadily increased past 30 years rates homicide increased dramatically u home office figures show increase rate homicide committed youngsters decade 1982 1992 average rate 84 convictions annum age range 10 20 home office research statistics department characteristics homicidal offenders classification types offender clinical experience indicates homicidal adolescents constitute heterogenous group american study cornell et al 1987 attempts classification juvenile homicide based circumstances offence state mind adolescent time authors subdivide group adolescent murderers follows 1 psychotic 2 conflict murder known people setting interpersonal tension subgroup adolescents commit parricide 3 crime murder strangers course committing crime keeping authors noted adolescent murderers psychotic crime group intoxicated time offence associated characteristics busch large scale american study busch et al 1990 compared 71 adolescents convicted homicide 71 matched non violent delinquent controls 94 homicide group male found adolescents kill tetrad features reach statistical significance distinguishing non violent controls features 1 criminally violent family members 2 gang membership 3 severe educational difficulties 4 alcohol abuse study replicated findings confirmed zagar study zagar 1991 30 american adolescents committed homicide study attempted compare homicidal adolescents violent homicidal control group 265 assessment adolescent homicide recently studies considered formal psychiatric state youngsters kill myers kemph 1990 attempted apply d m 3 classification psychiatric disorders 14 young american murderers main diagnoses conduct disorder substance abuse overlapping found instances psychotic disorder keeping researchers cornell et al 1987 toupin morissette 1990 labelle et al 1991 considered psychiatric diagnosis series canadian adolescents committed homicide diagnoses featured substance abuse time linked personality disorder incidence violence aspergers syndrome thoroughly reviewed ghaziuddin et al 1991 conclude evidence date support frequently held notion people aspergers syndrome likely violent aetiological factors theories psychological background factors family background studies agree marked psychopathology families homicidal adolescents frequently adolescent abused physically sexually neglect rejection discontinuity care corder et al 1976 post 1982 russell 1985 lewis et al 1985 criminal violence brutality rife homes parental mental illness alcoholism adolescent murderers scottish series fiddes 1981 found come large families displaying deprivation poor supervision criminality violent delinquents likely witnessed extreme violence homes aggressive delinquent peers lewis 1992 toupin morissette 1990 canadian study found level adversity homes group homicidal adolescents greater non homicidal offenders adolescents commit parricide corder et al 1976 post 1982 russell 1985 likely severely abused families adolescents described socially isolated controlled emotionally outlets express distress build rage pressure cooker effect frequently acting oedipal conflicts triangulated parents marital relationship coalition mother abusive father murdering parents postulated adolescent carrying covert wishes surviving parent problems research methodology family background considered widom 1989 examination cycle violence hypothesis emphasises need consider experience neglect distinct abuse quoting evidence neglected children actually show higher levels subsequent violent behaviour physically abused children makes point research shows children grow violent abusive homes violent adults future research needs address protective factors screen violence increasingly recognised witnessing violence youngsters important determinant violent behaviour abuse combination two lethal accepted violence learned modelling family controversial issue screen violence long time concern expressed youngsters adversely 266 p j hardwick m rowton lee influenced violence portrayed screen research date appears validate concern instance heath et al 1986 found interaction large amounts television viewing exposure parental abuse related criminal behaviour recent review research evidence linking television viewing violence children sege dietz 1994 conclude three decades research suggest causal link exposure children violent images television subsequent violent behaviour conclusion shared newson 1994 discussion paper parliament makes strong research based argument child health professionals recently seriously underestimated likely adverse effects screen violence children adolescents surprising television significant influence youngster behaviour personality development surveys show average american teenager spends time watching television talking family blum samuels 1990 evidence effect violent video games distinct forms screen violence producing antisocial behaviour youngsters inconclusive provenzo 1994 alert potential dangers realistic portrayal violence virtual reality mechanisms increasingly sophisticated portrayal violence entertainment adversely influence vulnerable youngsters proposed sege dietz 1994 point violence seen television frequent effective rewarded practiced heroes villains pain suffering caused minimised viewers encouraged identify perpetrators victims repeated exposure violent images desensitise people violence foster paranoid view world mean world syndrome media reporting violence known extent reporting media affects behaviour vulnerable young people possibility high publicity tabloids motivating factors young people murder schachter 1975 dietz 1986 individual psychopathology literature main theory understand homicide violent behaviour psychoanalytic theory mccarthy 1978 study 10 young murderers develops idea adolescents murder state primitive narcissistic rage fragile self esteem injured act murder said restore sense omnipotence represents attempt reparation self universal applicability theory assumed fact angry young people suffer injuries fragile self esteem murder addressed galatzer levy 1993 pursuing theme believes violence adolescence reverse side sense helplessness provides instant route sense power refers thrill associated violence psychodynamic themes frequently portrayed literature moulding homicidal personality providing motivation act instance maternal deprivation rejection features prominently seen lead persistence infantile rage lack self control poor ego development personality features remain unmodified youngster grows violent role models lack positive identity figures frequent formulation youngster rage depriving rejecting mother displaced outside family natural 267 assessment adolescent homicide mother despite defects idealised smith 1965 effects paternal deprivation modelling violent behaviour attention peer group influences case studies demonstrate adolescents show homicidal behaviour peers busch series 71 adolescent murderers 23 offences gang related details gangs relationship offences slaby stringham 1994 analyse situation peer violence perspectives aggressor victim bystander roles pointing roles interchangeable links knowledge victims abuse bullying perpetrators feel primarily victims research peer influences violence lethal non lethal advanced family factors biological developmental factors contribution biological factors brain damage violent behaviour general researched area researched juvenile homicide studies homicidal adolescents consider organic impairment studies report neurological features toupin morissette 1990 indicate findings previous head injury neurological impairment minority cases draw comment zagar controlled study zagar et al 1990 finds slightly increased incidence epilepsy central nervous system disorders infancy homicidal group compared describe non violent delinquent controls lewis et al 1985 describes prospective study group delinquent adolescents neuropsychiatrically evaluated followed subgroup nine youngsters subsequently committed murder displayed cns impairment epilepsy remaining delinquents murdered time re evaluation significance findings limited small numbers doubt cast wood 1961 description two adolescent murderers showing 6 14 second spike dysrhythmias eeg summary appear biological features different specific relationship homicide violent behaviour general turning literature general aggression juveniles brain damage cited contributing factor cases found abused boys neurological cognitive impairments far likely act aggressively central nervous system functions intact lewis 1992 effect brain damage likely mediated limitations areas social problem solving language impulse control clinically known seizure disorders cause violent outbursts rare considering genetic factors known xyy chromosome abnormality spurious connection violence vast majority xyy males violent lewis 1992 concludes genetic abnormality repeatedly demonstrated associated aggressive behaviour xy syndrome i e male condition educational difficulties recent studies drawn attention educational difficulties violent teenagers busch et al study 1990 found adolescents kill display significantly severe educational difficulties non violent delinquent controls high proportion homicidal adolescents display attention deficit hyperactivity disorders association learning difficulties 268 p j hardwick m rowton lee zagar replication study zagar et al 1990 examines educational difficulties detail iq homicide group slightly apparently significantly control group affected increased number adolescents mental retardation homicide group myers mutch 1992 interesting paper describe eight american juvenile murderers showed language disorder ranging mild severe speculate disorder contribute extreme violence youngsters likely coping skills stress tendency act talk feelings capacity rational thought understanding impaired myers mutch identify language assessment violent youngsters potentially fruitful area future research abuse recognised factor inhibit expressive language lewis 1992 developmental pathways studies shown considerable continuity violent behaviour time aggressive behaviour early life associated aggressive behaviour olweus 1979 estimated 70 90 violent offenders highly aggressive young loeber stouthamer loeber 1987 young children displaying attention deficit hyperactivity disorder adhd addition conduct problems carry high risk delinquency understanding continuity antisocial behaviour concept developmental pathways helpful farrington et al 1990 loeber 1990 loeber 1990 describes aggressive versatile path begins young child showing serious conduct problems adhd problems interfere social academic learning child disadvantaged poor relationships failure school home lead child dropping school identifying delinquents abusing substances youngsters violent behaviour associated antisocial activities pathway shows cumulative effect risk factors potentiate chain reactions circular causality situational factors act homicide arises interaction background priming factors current situational factors environmental stresses contribution substances disinhibitors availability weapons peer group influences psychiatric state referred environmental stresses malmquist 1971 describing 20 adolescent murderers analyses prodromal signs environmental stresses act featured losses relationships threats manhood emotional crescendo increasing agitation moody pre occupation prior killing adolescent experiences extreme feelings helplessness hopelessness losses significant relationships self esteem keeping authors e g marohn et al 1982 refers frequent co existence suicidal homicidal behaviour individual case studies parricide corder et al 1976 reveal youngsters reacting current family abuse alcohol substance abuse review connection substance abuse violent behaviour ages bradford et al 1992 conclude pharmacological action alcohol drugs increases likelihood aggression 269 assessment adolescent homicide impulsive aggression takers relationship violence alcohol better established drugs availability weapons convincing evidence availability guns heightens lethality violent behaviour united states controlled studies demonstrate higher risk homicide suicide homes guns kept webster wilson 1994 availability firearms responsible seven fold difference rate murder seattle u vancouver canada despite incidence assault two cities sloan et al 1988 possible predictive factors aetiological risk factors described far refer violent necessarily homicidal young person additional factors specifically differentiate likely commit murder violent kill apart chance victim dies threats authors malmquist 1971 miller looney 1974 point significant number adolescents commit murder previously signalled intentions helping agencies professionals threats fears committing homicide made direct number case histories literature described obvious ways youngsters expressed intentions content drawings essays duncan duncan 1971 area homicidal threats adolescents appear researched instance know distinguishes group go carry threats implication literature homicidal threats taken seriously bender series juvenile killers bender 1959 alarming half contact psychiatric services preceding homicide recommendations emerging psychiatric evaluation managing potential violence frequently followed anger control literature varies extent homicidal adolescents displayed previous violence pattern previous violent behaviour helps predict homicide case studies confirm developmental pathway involving long history aggressive outbursts poor impulse control inability tolerate frustration case studies series portray homicidal adolescents overcontrolled emotionally prone build rage pressure cooker effect instance corder et al 1976 found adolescents commit parricide show history prior aggression groups murderers walshe brennan 1977 found young murderers actual previous convictions review loeber stouthamer loeber 1987 quoted earlier indicates 10 30 violent offenders aggressive youngsters cognitive factors potentially fruitful line research consider particular beliefs constructs preoccupations youths kill date appears little systematic inquiry area mental content referred individual case studies cognitions fall four broad areas youngsters prior offence display preoccupation fantasies death violence 270 p j hardwick m rowton lee killing bender 1959 duncan duncan 1971 youngsters displaying paranoid ideation misperceptions lewis 1992 confuse fantasy life reality live state borderline reality lempp 1990 youngsters show impaired empathy significant capacity dehumanise miller looney 1974 grecco cornell 1992 miller looney 1974 take cognitive approach addressing issue distinguishes adolescent commits murder violent homicidal postulate additional determinants homicidal distinct nonmurderous aggression 1 extreme capacity perpetrator dehumanise pervasively intermittently involves viewing people human realm persecutory objects thwarting desires 2 violence slaughter egosyntonic level acceptable forms behaviour display marked dehumanisation peace time dehumanised abuse deprivation childhood likely experienced incomprehensible intrafamilial violence capacity dehumanise accompanied unclear distinction life death greco cornell 1992 controlled study rorschach responses 55 homicidal adolescents found adolescents murder context crime show significantly poorer object relations higher capacity dehumanise adolescents murdering context interpersonal conflict latter adolescents differ object relations non violent controls identity formation violent young people far little specific attention known abuse field survivors abuse adopt victim identity identify abuser go perpetrators abuse violence processes involved understood case known authors sabbatical year united states 1970s volcano vacuum syndrome unpublished illustrates contribution morbid identity episode homicide background teenage perpetrator j marked discontinuity care lack real attachments spent life local authority care oscillating carers institutions bottling resentment denied basic needs parenting family life growing vacuum attachments received encouragement develop positive identity gravitated morbid identity expressed power status wished life outlet anger years prior offence produced drawings revealed obsession identification violent film characters expressed thirst power revenge violence contact j described controlled emotionally previous convictions history aggression eventually break first heterosexual relationship volcano erupted j acted theme drawings violent rampage murder years prior offence j expressed fear professionals act murderous fantasies assessment management homicidal risk literature confirms assessing homicidal risk adolescent remains matter 271 assessment adolescent homicide vulnerability background factors family factors society attitude violence violence screen availability weapons abuse neglect rejection violence witnessed criminality alcoholism biological brain damage learning difficulites impaired language impulsivity attention deficit personality cognitive long history aggression control anger reservoir anger homicide threats fantasies capacity dehumanise morbid identity paranoid ideation situational factors losses rejecton relationships threats manhood self esteem emotional crescendo hopelessness helplessness disinhibitors drugs alcohol crime group processes psychiatric state homicidal behaviour homicide chance contribution victim figure 1 relatively unrefined clinical judgement achieved carefully considering cumulative interaction constellation variables biological psychological vulnerability factors environmental stresses triggers attitude violence displayed society availability weapons systemic view possible contribution act victim i e knowledge people place dangerous situations cases chance dictates event homicide non homicidal violence factors unearthed review implicated homicide adolescents need considered assessing risk summed figure 1 youngsters atrisk greatest number degree severity risk factors risk factors potentiate biologically disadvantaged youngster showing cns damage impulsivity language learning difficulties suffered abuse witnessed severe violence develop paranoid dehumanising mental environmental circumstances involving threat self esteem violent assessment risk adolescents capacity acknowledge take responsibility 272 p j hardwick m rowton lee dangerousness degree motivation change specificity threats victim level co operation professionals need considered amount support available deter homicidal youngster acting impulses important assessment indicates high risk dangerousness potentially dangerous youngsters present helping services remains problem effectively intervene perspective child adolescent mental health services resourced struggling stay afloat proves difficult offer intensity intervention required engage high risk juveniles families engagement successful variety approaches individual family therapy required individuals specific anger management programmes benefit youngsters need alternative care inpatient treatment required 16s accommodated adult psychiatric hospitals contrary national advice secure therapeutic residential units youngsters country scant literature available treatment children adolescents committed homicide reviewed myers 1992 wide range approaches attempted united states outcome studies lacking prevention far discussion risk assessment concentrated adolescents threatening displaying violence come attention professionals finding aggressive behaviour frequently begins early life follow developmental pathway violence adolescence carries prospect preventive action implies need awareness potential seriousness aggression impulsivity young children showing learning difficulties disadvantaged backgrounds implies need adequate services provide intervention focussing pathway distract attention potential violence controlled youngsters escalating youth violence north american continent prompting discussion wide range professionals tackle recent conference paediatricians spivak harvey 1994 supports wide range interventions re shaping attitudes violence society public education outlawing corporal punishment reducing exposure screen violence reducing opportunities violence making weapons accessible screening risk children targeting interventions home school neighbourhood interventions parent training teaching conflict resolution skills treatment victims violence future directions research research needed develop sophisticated approach assessment management homicide risk youngsters number factors make research homicide slow advance distinct research 273 assessment adolescent homicide non lethal violence firstly adolescent homicide rare event difficult study large numbers studies far come north america care needed extrapolating results british population national international collaborative studies needed secondly research retrospective based accounts youngsters adults entered penal system creates obvious bias thirdly particular factor hindering research britain emphasis juveniles murdered illustrated recent cases judicial enquiry establishing guilt understanding causal factors future research usefully give attention cognitive processes constructs violent youngsters prove beneficial addressing question drives youngster commit homicide perpetrate non lethal violence leaving aside effects chance determining violent act results death development morbid identity associated preoccupation fantasies death violence paranoid ideas distorted concept death encourages dehumanisation particular relevance understanding characteristics youngsters influenced screen violence developing morbid identity needed effects forms abuse bullying identity formation violent youngsters needs understanding important note definition abuse widening mutilating surgery early life recently incriminated clinical anecdotes research developmental pathways family backgrounds volcanic youngsters history control prove useful important remember considering aggressive pathway youngsters veer path violent teenagers knowledge protective factors help designing intervention programmes lastly research effectiveness interventions energetic public health measures currently undertaken america vital conclusion backgrounds situations homicidal youngsters highly problematic stand significantly different traumatic backgrounds aggressive youngsters present professionals frightening implication youngsters capable homicide violent behaviour end homicide chance america tackling violence major public health issue view authors problem violence needs addressed energy levels united kingdom societal level climate needed easier males talk feelings problems act implies promoting macho role models males facilitated glorification violence screen easy acquisition weapons needs acknowledged negative feelings times stigma attached males admitting problems feelings seeking help high numbers risk juveniles inadequate family situations emphasises need societal change order empower families communities care better children 274 p j hardwick m rowton lee better resourced range support intervention services child adolescent mental health urgently needed facilitated relevant agencies local level meeting draw inter agency guidelines management dangerousness process highlight resource implications child adolescent mental health services need designed adolescent friendly accessible stigmatising staff time skills imaginatively engage youngsters therapeutic work need offer range interventions sufficient intensity develop particular approaches tackle violence family risk youngsters need identifying early life provided follow prevent lost professional network measures offer improvement current situation high risk adolescents frequently communicating dangerousness avoid mental health services lastly appears little attention assessment management homicidal risk youngsters training child adolescent mental health professionals authors little mention topic number standard textbooks contrast attention self harm assessment 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